Nutritional status of children and adolescents based on body mass index: agreement between World Health Organization and International Obesity Task Force

MULT: A new BMI reference to assess nutritional status of multi-ethnic children and adolescents

OBJECTIVES

To develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi-ethnic populations and to compare it to international BMI references.

METHODS

The MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0-22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z-scores (population level) and based on BMI z-scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old.

RESULTS

MULT presented the lowest mean BMI values for the ages 102-240 months for boys and 114-220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references.

CONCLUSION

The MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi-ethnic populations.

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review

Abstract Objective: To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012). Data source: We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: “Child”, “Adolescent”, “Nutritional Assessment”, “Growth Chart”, “Ethnic Groups”, “Stature by age”, “Body Mass Index”, “Comparison”, “CDC”, “WHO”, and “IOTF”. The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH. Data synthesis: Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations. Conclusions: There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Anthropometry analysis of nutritional indicators in Indonesian adolescents

Objective

Malnutrition is an emerging health problem that has challenged healthcare authorities worldwide. This study aims to determine anthropometric values and the nutritional status of Indonesian school adolescents.

Methods

In total, 510 students (288 girls and 222 boys) studying at Darul Ihsan Islamic Boarding School Banda Aceh participated in this cross-sectional study. All participants were examined for weight, height, and body mass index (BMI). The BMI category was classified using BMI criteria for the Asia-Pacific population. For data analysis, a descriptive analysis, chi-square (p < 0.05), and independent sample t-test (p < 0.05) were employed.

Results

The rate of malnutrition among school adolescents in Banda Aceh was underweight 36.67% (girls = 47.6% and boys = 52.4%) and overweight/obesity 21.96% (girls = 60.66% and boys = 39.33%). There was a significant difference in the number of overweight girls and boys: 127 (60.2%) and 84 (39.8%) p = 0.007, respectively. Obesity I was more common among girls than boys: (31; 66%) versus (16; 34%), p = 0.020. There was a slight difference in the prevalence of being underweight: 89 (47.6%) versus 98 (52.4%), p = 0.520, and no difference in the number of girls and boys with obesity II: 6 (50%) versus 6 (50%), respectively.

Conclusions

This study reports multiple malnutrition problems in adolescent schools in Banda Aceh, namely being underweight, overweight, and obesity. This calls for urgent attention by healthcare authorities to initiate public awareness campaigns to curtail malnutrition.

Cardiovascular risk factors in children

INTRODUCTION

Systemic hypertension is one of the main risk factors for cardiovascular disease (CVD). Early diagnosis and treatment of hypertension in childhood can potentially have a significant impact on future adverse outcomes.

OBJECTIVE

To investigate the relationship of diastolic (DBP) and systolic blood pressure (SBP) with anthropometric data and area of residence of children in municipalities of Rio Grande do Sul state, Brazil.

METHODS

This is a cross-sectional study of 709 children between six and nine years of age. Blood pressure, weight, height and waist circumference (WC) were measured. Statistical tests had a maximum significance level of 5% (p≤0.05) and the software used was SPSS version 13.0.

RESULTS

Obesity was significantly associated with pre-hypertension, and stage 1 and 2 hypertension as assessed by DBP and SBP (≤0.05); high WC was significantly associated with a classification of pre-hypertension and stage 1 hypertension based on DBP and a classification of stage 1 and 2 hypertension based on SBP (≤0.01).

CONCLUSION

Children living in urban areas had significantly higher mean SBP than those living in rural areas. Those with high WC presented higher SBP and DBP compared to children with normal WC. Obese children showed higher mean SBP and DBP compared to those who were overweight or normal weight and mean SBP and DBP also increased with older age and higher mean body mass index and WC.

Changes of Overweight and Obesity Prevalence Among School Children in North West of Iran After 3 Years Follow-up (2009-2011): A Longitudinal Study

Background:

Obesity and overweight among children is a major public health problem in developed and developing countries and has important health and economic implications. This longitudinal study aimed to assessing the prevalence trend of overweight and obesity in West Azerbaijan in North West of Iran.

Methods:

This study was a longitudinal follow-up study and was conducted in school children at 2009–2011 year. The subjects were all school children (12 years of age) that were recruited from rural and urban schools in West Azerbaijan. Overall, 22,820 girls and 28,763 boys were enrolled in 2009 and were followed for 3 years. A body mass index (BMI) 85^th–95^th percentile was classified as overweight and a BMI >95^th percentile was classified as obese. All statistical analyses were performed using the Excel Software. Descriptive statistics were used to characterize the sample in different time periods. The prevalence was calculated as the ratio of number of present cases to a given population number in a given subgroup at a given time.

Results:

In urban schools, the prevalence of overweight among girls and boys was 118.26 and 103.9 per 1000 persons in 2009 year, respectively, and this trend was increased in both girls (152.90 per 1000 persons) and boys (125.72 per 1000 persons) in 2011. The obesity trend was increased among both girls and boys (22.26 and 26.52 among girls and boys in 2009 to 24.66 and 28.65 per 1000 persons in 2011), respectively. In rural schools, the prevalence of overweight among girls was increased from 84.5 in 2009 to 108.89 per 1000 persons in 2011, but this trend was decreased among boys (from 95.49 in 2009 to 43.9 per 1000 persons in 2011), and the prevalence of obesity among boys was increased at the end of follow-up, but this trend was decreased among girls.

Conclusions:

Overweight and obesity in children has increased. Further studies are necessary to evaluate the relationship between obesity and overweight and risk factors such as dietary pattern and physical inactivity.

Depressive and Anxiety Symptoms Predict Sustained Quality of Life Deficits in HIV-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study

The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period. Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in relation to quartiles of each psychosocial status indicator. Repeated measures generalized estimating equations modeling was implemented to assess differences in likelihood of improved versus nonimproved SRH during follow-up.QOL scores and SRH improved significantly for all participants over 18 months (P < 0.0001). The gain in QOL increased dose-dependently as baseline depressive symptoms (time*depression P < 0.001) and anxiety levels (time*anxiety P < 0.001) declined. Lower social support was associated with worse QOL at baseline (P = 0.0005) but QOL improvement during follow-up was not dependent on baseline level of social support (time*social support P = 0.8943) or number of stigmatizing experiences (time*stigma P = 0.8662). Psychosocial determinants did not predict changes in SRH in this study. High levels of depression and anxiety symptoms at HAART initiation predicts lower gains in QOL for HIV-positive patients for as long as 18 months. Long-term QOL improvements in HIV-infected adults may be enhanced by implementation of psychosocial interventions to reduce depression and anxiety in HIV-infected adults.

High perceived social standing is associated with better health in HIV-infected Ugandan adults on highly active antiretroviral therapy

Perceived social standing (PSS) was evaluated as a determinant of differences in health outcomes among Ugandan HIV-infected adults from Kampala using cross-sectional study design. PSS was defined using the MacArthur scale of subjective social status translated and adapted for the study setting. Socio-demographic and psychosocial correlates of PSS ranking at enrollment were determined using linear regression models. High versus low PSS was defined based on the median PSS score and evaluated as a determinant of body mass index, hemoglobin, quality of life (QOL) and frailty-related phenotype via linear regression. A log-binomial regression model estimated the relative-risk of good, very good or excellent versus fair or poor self-rated health (SRH) in relation to PSS. Older age, increasing social support and material wealth were correlated with high PSS ranking, whereas female sex, experience of multiple stigmas and multiple depressive symptoms were correlated with low PSS ranking. High PSS participants were on average 1.1 kg/m(2) heavier, had 4.7 % lower frailty scores and 3.6 % higher QOL scores compared to low PSS patients (all p < 0.05); they were also more likely to self-classify as high SRH (RR 1.4, 95 % confidence interval 1.1, 1.7) but had comparable hemoglobin levels (p = 0.634). Low PSS correlated with poor physical and psychosocial wellbeing in HIV-positive Ugandan adults. The assessment of PSS as part of clinical management, combined with efforts to reduce stigma and improve social support, may identify and possibly reduce PSS-associated health inequality in Ugandan adults with HIV.

Trend of Overweight and Obesity, Based on Population Study among School Children in North West of Iran: Implications for When to Intervene

INTRODUCTION

Childhood overweight and obesity is a major public health problem in both developed and developing countries. Overweight and obesity in children may have severe consequences later in a dolescence and adulthood. The aim of current study was to determine the prevalence trend of overweight and obesity in school-aged children from 2009 to 2011.

METHODS

The present study was a population-based study and conducted in three consecutive years, from 2009 to 2011. The study population included all of primary, secondary and high school children in rural and urban regions of West Azerbaijan province in West-North of Iran. Body mass index (BMI), the ratio of weight to height squared [weight (kg)]/ [height (m)]2, was calculated to the nearest decimal place. Overweight and obesity were classified using CDC recommendations for age and sex: a BMI 85th- 95th percentile was classified as overweight and a BMI >95th percentile was classified as obese. All statistical analyses were performed using the Excel Software. Descriptive statistics were used to characterize the sample in different time periods. The prevalence was calculated as the ratio of number present cases to a given population number in a given subgroup at a given time.

RESULTS

Overall, 165740, 145146 and 146203 school children were assessed at 2009, 2010 and 2011, respectively. Prevalence of overweight in primary school children among girls were 52.83, 86.93 and 116.36 and for boys were 57.07, 53.4 and 93.55 per 1000 person in 2009, 2010 and 2011 years, respectively. The prevalence of obesity in secondary school children for girls were 22.26, 27.75 and 28.43 and 26.52, 25.72 and 35.85 for boys per 1000 person in 2009, 2010 and 2011, respectively, The highest prevalence of overweight was 77.58, 142.4 and 126.46 per 1000 person among primary, secondary and high school children, respectively, in 2011. The lowest prevalence of obesity was 12.52, 24.1 and 21.61 per 1000 person among primary, secondary and high school children, respectively, in 2009.

CONCLUSIONS

However, the rapid increase in both obesity and overweight should have a special attention. Research on prevalence trend of overweight and obesity in children is poorly reported in Iran. So that, future studies need to follow-up on the associations between overweight and obesity with health outcomes when children develop and reach adolescence and adulthood.

Associação entre estado nutricional, aleitamento materno exclusivo e tempo de internação hospitalar de crianças

RESUMO Objetivo Verificar a associação entre estado nutricional, aleitamento materno exclusivo e tempo de internação hospitalar de crianças. Método Estudo transversal. Amostra por conveniência, com 146 crianças de 1-48 meses e seus responsáveis. Dados coletados em unidades pediátricas de um hospital do sul do Brasil, entre janeiro e agosto de 2012. Para análise, utilizaram-se os coeficientes de correlação de Pearson e de Spearman. Resultados As crianças foram classificadas em: eutróficas (71,9%), risco para sobrepeso (13,0%); obesidade (6,2%); magreza (4,1%); sobrepeso (2,7%) e magreza acentuada (2,1%). O aleitamento materno exclusivo demonstrou ser um fator de proteção contra a magreza acentuada (P=0,029); estar sendo amamentado (P=0,024) ou ter sido amamentado (P=0,000) foram identificados como fatores de proteção contra sobrepeso, risco para sobrepeso e obesidade. O tempo de internação hospitalar foi maior para sobrepeso/obesidade e menor para magreza acentuada/magreza (P=0,785). Conclusão Inadequado estado nutricional e desmame precoce não foram fatores de risco para o maior tempo de internação nesta amostra.